My husband, who runs a small business with three employees, came to me for advice on a topic on which I am supposed to be an expert -- health insurance. My husband employs three people, all of whom have worked for him for years. He is deeply committed to giving his employees health insurance. But he just doesn't know what to do.

He is paying $3,400 each month for insurance just for his three employees. (He gets his own health insurance through me.) This costs him $41,000 per year, about what he would pay to hire another person. Even at this rate, his employees still have co-pays for all doctor's services, and must shoulder 10 to 30 percent of the cost of medical procedures and hospitalizations. The insurance companies give no reason for the increase.

My husband's choices are to keep the same plan and somehow swallow a 15 percent increase to $48,000 per year, or decrease the business's cost by shifting more of the cost to his employees, one of whom has a wife with multiple sclerosis. "Isn't there something else I can do?" he asks. "At this rate, I might have to let go of one employee just to keep health insurance for the other two."

What can I say? His choice is a terrible one.

As the CEO of a health management organization, I know that our health insurance system -- the one you and I depend on every day -- is on the verge of collapse because too many employers just can't afford it anymore. If you ask me, we should have Medicare for everyone, and employers (who would be relieved of their insurance costs) and individuals should share responsibility for the cost just as we do for Medicare. This is the ultimate "free choice" solution, allowing each of us to choose our own doctors and hospitals, and even enroll in a health plan, if we so choose. Such a model eliminates most of the wasteful administrative costs in our system. It would also be relatively easy to implement by using our Social Security numbers.

But while this would be my preferred solution, I won't object to any other solution that gives us universal coverage.

That's why I am so hopeful about what is going on in our state. Gov. Arnold Schwarzenegger, Assembly Speaker Fabian Núñez and Senate President Pro Tem Don Perata, each of whom have a proposal for universal coverage, have made a critical change in the health-care debate. The issue is no longer whether we need to get to universal coverage, but how we are going to get there.

I am proud that San Francisco has played a part in creating the political momentum that has created this paradigm shift. While implementing an employer health-care spending mandate and a Health Access Program will be challenging -- and some may say not the ideal way to go -- at least we have committed ourselves as a community to trying to find solutions instead of waiting for someone else to show leadership. Interestingly, the employers in focus groups that we held recently were nearly unanimous in saying that the health-care system had to be fixed by the government.

It won't be easy to agree on a solution, but I urge everyone involved to remember that we cannot let our individual beliefs about the "best" system impede us from implementing a "decent" system. For better or worse, compromise is at the heart of our political system. We can always tinker with things after we have made sure that everyone has at least basic health coverage.

My husband is not alone in his dilemma; thousands of small businesses face a similar problem every day. It is the job of our elected leaders to solve this dilemma. If they can just stay focused on the goal -- universal coverage -- and steer clear of bending too much to special interests, I believe California can lead the way for the rest of the nation.